1
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Divya Bhargavi P, Lolla S, Sugunan S, Shiva Gubbiyappa K, Ali Khan A, Alanazi AM, Vijay Nayak B. The simultaneous quantification of Sitagliptin and Irbesartan in rat plasma using the validated LC-MS/MS method is applied to a pharmacokinetic study. J Chromatogr B Analyt Technol Biomed Life Sci 2023; 1221:123677. [PMID: 36958118 DOI: 10.1016/j.jchromb.2023.123677] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 03/04/2023] [Accepted: 03/13/2023] [Indexed: 03/18/2023]
Abstract
Irbesartan (IRB), an angiotensin II receptor AT1 blocker, is an antihypertensive agent commonly used with Sitagliptin (STG), a novel antidiabetic agent in diabetes. A finalised and validated LC-MS/MS method was used for the bioanalytical quantification of STG and IRB to be applicable to studies on the P.K drug-drug interactions between STG and IRB. Using a YMC triart C18 column (50 mm × 4.6 mm i.d., 3 µm), both the drugs and the Tolbutamide were separated using a gradient mode with a flow rate of 1 ml/min with run time of 5 min. For analyte detection, an LC-MS/MS system with multiple reaction monitoring (MRM) was used. The technique was validated across a concentration range of 5-1000 ng/ml, with the LLOQ for both analytes being 5 ng/ml. At all QC levels accuracies from spiked samples were > 83% for both drugs and internal standards. The accuracy for STG within-batch and between-batch was found within 98.4-107.2%, and for IRB was found within 92.4-102.5%. The precision for STG within batch and between batches was less than 12.3% CV, and for IRB was less than 10.2% CV at all concentration levels. The pharmacokinetic profiles of STG and IRB were successfully applied on simultaneous oral administration to rats. This method applies to pharmacokinetic multidrug interaction studies.
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Affiliation(s)
- P Divya Bhargavi
- Department of Pharmacognosy, JSS College of Pharmacy, Ooty, Tamil Nadu 643001, India
| | - Siddhartha Lolla
- Department of Pharmaceutical Analysis, GITAM School of Pharmacy, Deemed to be University, Hyderabad, Telangana 502032, India; Novel Global Community Educational Foundation, Australia
| | - Sinoy Sugunan
- Department of Pharmaceutical Analysis, GITAM School of Pharmacy, Deemed to be University, Hyderabad, Telangana 502032, India
| | - Kumar Shiva Gubbiyappa
- Department of Pharmaceutical Analysis, GITAM School of Pharmacy, Deemed to be University, Hyderabad, Telangana 502032, India
| | - Azmat Ali Khan
- Pharmaceutical Biotechnology Laboratory, Department of Pharmaceutical Chemistry, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Amer M Alanazi
- Pharmaceutical Biotechnology Laboratory, Department of Pharmaceutical Chemistry, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Bhukya Vijay Nayak
- Department of Pharmaceutical Analysis, GITAM School of Pharmacy, Deemed to be University, Hyderabad, Telangana 502032, India.
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2
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Assessment of potential drug–drug interactions among outpatients in a tertiary care hospital: focusing on the role of P-glycoprotein and CYP3a4 (retrospective observational study). Heliyon 2022; 8:e11278. [PMID: 36387483 PMCID: PMC9641194 DOI: 10.1016/j.heliyon.2022.e11278] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/26/2022] [Accepted: 10/21/2022] [Indexed: 11/06/2022] Open
Abstract
Background Selecting a medicine has a significant impact on the quality of therapy including efficacy and safety. P-glycoprotein and CYP3A4 share several common substrates known as bi-substrates. Both play major role in the pharmacokinetics and pharmacodynamics when over or under expressed. Objective The study aimed to assess the Drug–Drug Interaction (DDI) related to P-glycoprotein (P-gp) and Cytochrome P450-3A4 (CYP3A4), to predict their clinical outcomes and also to discover prospective predictors of pDDIs. Methods The subjects in this retrospective study ranged in age from 18 to 95 years with polypharmacy prescriptions. Information was gathered through patient medical records. Based on Micromedex and previous literature studies, medications prescribed to the patients were observed for pDDIs according to risk rating scale for drug interactions. Results A total of 504 patients (160 males and 344 females) were included in the study. The mean of pDDI seen in the patients was 1.66 ± 1.48 and total 825 pDDIs were discovered. The factors significantly associated with having ≥1 pDDIs included: taking ≥5 medicines (OR 1.747), increased age (OR 1.026) increased comorbidities (OR 1.73). Conclusion In prescriptions, a considerable number of probable DDI were discovered. Therefore, careful selection of drugs and identification of mechanisms for DDI is needed to lower the frequency of pDDI.
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3
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Mar PL, Horbal P, Chung MK, Dukes JW, Ezekowitz M, Lakkireddy D, Lip GYH, Miletello M, Noseworthy PA, Reiffel JA, Tisdale JE, Olshansky B, Gopinathannair R. Drug Interactions Affecting Antiarrhythmic Drug Use. Circ Arrhythm Electrophysiol 2022; 15:e007955. [PMID: 35491871 DOI: 10.1161/circep.121.007955] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Antiarrhythmic drugs (AAD) play an important role in the management of arrhythmias. Drug interactions involving AAD are common in clinical practice. As AADs have a narrow therapeutic window, both pharmacokinetic as well as pharmacodynamic interactions involving AAD can result in serious adverse drug reactions ranging from arrhythmia recurrence, failure of device-based therapy, and heart failure, to death. Pharmacokinetic drug interactions frequently involve the inhibition of key metabolic pathways, resulting in accumulation of a substrate drug. Additionally, over the past 2 decades, the P-gp (permeability glycoprotein) has been increasingly cited as a significant source of drug interactions. Pharmacodynamic drug interactions involving AADs commonly involve additive QT prolongation. Amiodarone, quinidine, and dofetilide are AADs with numerous and clinically significant drug interactions. Recent studies have also demonstrated increased morbidity and mortality with the use of digoxin and other AAD which interact with P-gp. QT prolongation is an important pharmacodynamic interaction involving mainly Vaughan-Williams class III AAD as many commonly used drug classes, such as macrolide antibiotics, fluoroquinolone antibiotics, antipsychotics, and antiemetics prolong the QT interval. Whenever possible, serious drug-drug interactions involving AAD should be avoided. If unavoidable, patients will require closer monitoring and the concomitant use of interacting agents should be minimized. Increasing awareness of drug interactions among clinicians will significantly improve patient safety for patients with arrhythmias.
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Affiliation(s)
- Philip L Mar
- Department of Medicine, Division of Cardiology, St. Louis University, St. Louis, MO (P.L.M., P.H.)
| | - Piotr Horbal
- Department of Medicine, Division of Cardiology, St. Louis University, St. Louis, MO (P.L.M., P.H.)
| | - Mina K Chung
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute (M.K.C.), Cleveland Clinic, OH
| | | | - Michael Ezekowitz
- Lankenau Heart Institute, Bryn Mawr Hospital & Sidney Kimmel Medical College (M.E.)
| | | | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool & Liverpool Heart & Chest Hospital, Liverpool, United Kingdom (G.Y.H.L.).,Department of Clinical Medicine, Aalborg, Denmark (G.Y.H.L.)
| | | | - Peter A Noseworthy
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (P.A.N.)
| | - James A Reiffel
- Division of Cardiology, Department of Medicine, Columbia University, New York, NY (J.A.R.)
| | - James E Tisdale
- College of Pharmacy, Purdue University (J.E.T.).,School of Medicine, Indiana University, Indianapolis (J.E.T.)
| | - Brian Olshansky
- Division of Cardiology, Department of Medicine, University of Iowa, Iowa City (B.O.)
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Repurposing colchicine's journey in view of drug-to-drug interactions. A review. Toxicol Rep 2021; 8:1389-1393. [PMID: 34285885 PMCID: PMC8280530 DOI: 10.1016/j.toxrep.2021.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 05/10/2021] [Accepted: 07/08/2021] [Indexed: 12/15/2022] Open
Abstract
Colchicine's medical evolution is historically bound to the Mediterranean basin, since remarkable researchers from this region underscored its valuable properties. With the passing of years colchicine became an essential pharmaceutical substance for the treatment of rheumatologic and cardiovascular diseases. In light of recent findings, the therapeutic value of colchicine has grown. In clinical practice, colchicine remains underutilized in view of its proven efficacy and safety. Its complex pharmacokinetics and multifaceted anti-inflammatory role remain under investigation. The current review addresses the safe administration of colchicine in view of key drug to drug interactions. Finally, we are briefly presenting colchicine's future potential applications.
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Kawano Y, Nagata M, Nakamura S, Akagi Y, Suzuki T, Tsukada E, Hoshiko M, Kujirai A, Nakamatsu S, Nishikawa T, Enomoto A, Negishi K, Shimada S, Aoyama T, Mano Y. Comprehensive Exploration of Medications That Affect the Bleeding Risk of Oral Anticoagulant Users. Biol Pharm Bull 2021; 44:611-619. [PMID: 33952817 DOI: 10.1248/bpb.b20-00791] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Oral anticoagulants (OACs) pose a major bleeding risk, which may be increased or decreased by concomitant medications. To explore medications that affect the bleeding risk of OACs, we conducted a nested case-control study including 554 bleeding cases (warfarin, n = 327; direct OACs [DOACs], n = 227) and 1337 non-bleeding controls (warfarin, n = 814; DOACs, n = 523), using a Japanese health insurance database from January 2005 to June 2017. Major bleeding risk associated with exposure to concomitant medications within 30 d of the event/index date was evaluated, and adjusted odds ratios (aORs) were calculated using logistic regression analysis. Several antihypertensive drugs, such as amlodipine and bisoprolol, were associated with a decreased risk of bleeding (warfarin + amlodipine [aOR, 0.64; 95% confidence interval (CI): 0.41-0.98], DOACs + bisoprolol [aOR, 0.51; 95% CI, 0.33-0.80]). As hypertension is considered a significant risk factor for intracranial bleeding in antithrombotic therapy, antihypertensive drugs may suppress intracranial bleeding. In contrast, telmisartan, a widely used antihypertensive drug, was associated with an increased risk of bleeding [DOACs + telmisartan (aOR, 4.87; 95% CI, 1.84-12.91)]. Since telmisartan is an inhibitor of P-glycoprotein (P-gp), the elimination of rivaroxaban and apixaban, which are substrates of P-gp, is hindered, resulting in increased blood levels of both drugs, thereby increasing the risk of hemorrhage. In conclusion, antihypertensive drugs may improve the safety of OACs, and the pharmacokinetic-based drug interactions of DOACs must be considered.
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Affiliation(s)
- Yohei Kawano
- Faculty of Pharmaceutical Sciences, Tokyo University of Science (TUS)
| | - Masashi Nagata
- Department of Pharmacy, Medical Hospital, Tokyo Medical and Dental University (TMDU)
| | - Saeko Nakamura
- Faculty of Pharmaceutical Sciences, Tokyo University of Science (TUS)
| | - Yuuki Akagi
- Faculty of Pharmaceutical Sciences, Tokyo University of Science (TUS).,Department of Pharmacy, National Hospital Organization Yokohama Medical Center
| | - Tatsunori Suzuki
- Faculty of Pharmaceutical Sciences, Tokyo University of Science (TUS)
| | - Emi Tsukada
- Center Hospital of the National Center for Global Health and Medicine (NCGM)
| | - Mai Hoshiko
- Faculty of Pharmaceutical Sciences, Tokyo University of Science (TUS)
| | - Azusa Kujirai
- Faculty of Pharmaceutical Sciences, Tokyo University of Science (TUS)
| | - Satoshi Nakamatsu
- Faculty of Pharmaceutical Sciences, Tokyo University of Science (TUS)
| | - Tomoki Nishikawa
- Faculty of Pharmaceutical Sciences, Tokyo University of Science (TUS)
| | - Aya Enomoto
- Department of Pharmacy, Medical Hospital, Tokyo Medical and Dental University (TMDU)
| | - Kenichi Negishi
- Faculty of Pharmaceutical Sciences, Tokyo University of Science (TUS)
| | - Shuji Shimada
- Faculty of Pharmaceutical Sciences, Tokyo University of Science (TUS)
| | - Takao Aoyama
- Faculty of Pharmaceutical Sciences, Tokyo University of Science (TUS)
| | - Yasunari Mano
- Faculty of Pharmaceutical Sciences, Tokyo University of Science (TUS)
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6
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Azam C, Claraz P, Chevreau C, Vinson C, Cottura E, Mourey L, Pouessel D, Guibaud S, Pollet O, Le Goff M, Bardies C, Pelagatti V, Canonge JM, Puisset F. Association between clinically relevant toxicities of pazopanib and sunitinib and the use of weak CYP3A4 and P-gp inhibitors. Eur J Clin Pharmacol 2020; 76:579-587. [PMID: 31932871 DOI: 10.1007/s00228-020-02828-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 01/03/2020] [Indexed: 01/10/2023]
Abstract
PURPOSE Sunitinib and pazopanib, two tyrosine kinase inhibitors (TKI), may be targets of potential pharmacokinetic drug-drug interactions (P-PK-DDIs). While strong cytochrome P4503A (CYP3A4) inhibitors or inducers should cause a clinically relevant modification in plasma TKI concentrations, the effect of weak inhibitors is unknown. The objective of this study was to evaluate the association between weak P-PK-DDI and clinically relevant toxicity in real life. PATIENTS AND METHODS This was a single-center retrospective study including patients treated with sunitinib or pazopanib for any malignancies, for whom a PK-DDI analysis was performed before starting TKI. The primary endpoint was the correlation between P-PK-DDIs and a dose decrease after 1 month of treatment. The secondary endpoint was the correlation between PK-DDIs and drug withdrawal due to toxicity. RESULTS Seventy-six patients were assessed. A P-PK-DDI with weak CYP3A4 or P-gp inhibition was found in 14 patients. In patients with P-PK-DDI or without, the dose was reduced during the first month in 57.1% and 17.7% (p = 0.003) and the drug withdrawn in 42.8% and 11.3% (p = 0.011), respectively. In multivariate analysis, a significant correlation was found between P-PK-DDI (CYP3A4 and P-gp inhibitors) and dose reduction, and between drug withdrawal and PK-DDI (CYP3A4 inhibitors). CONCLUSION P-PK-DDI was correlated with dose reduction and drug withdrawal due to toxicity. The causality of this relationship warrants to be assessed; therefore, therapeutic drug monitoring is necessary in patients treated with TKI.
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Affiliation(s)
- Camille Azam
- Pharmacy department IUCT (Institut Universitaire du Cancer) Oncopole, Institut Claudius Regaud, 1 avenue Irène Joliot-Curie, Toulouse CEDEX 9, 31059, France
| | - Pauline Claraz
- Pharmacy department IUCT (Institut Universitaire du Cancer) Oncopole, Institut Claudius Regaud, 1 avenue Irène Joliot-Curie, Toulouse CEDEX 9, 31059, France
| | - Christine Chevreau
- Oncology department IUCT (Institut Universitaire du Cancer) Oncopole, Institut Claudius Regaud, 1 avenue Irène Joliot-Curie, Toulouse CEDEX 9, 31059, France
| | - Camille Vinson
- Pharmacy department IUCT (Institut Universitaire du Cancer) Oncopole, Institut Claudius Regaud, 1 avenue Irène Joliot-Curie, Toulouse CEDEX 9, 31059, France
| | - Ewa Cottura
- Oncology department IUCT (Institut Universitaire du Cancer) Oncopole, Institut Claudius Regaud, 1 avenue Irène Joliot-Curie, Toulouse CEDEX 9, 31059, France
| | - Loïc Mourey
- Oncology department IUCT (Institut Universitaire du Cancer) Oncopole, Institut Claudius Regaud, 1 avenue Irène Joliot-Curie, Toulouse CEDEX 9, 31059, France
| | - Damien Pouessel
- Oncology department IUCT (Institut Universitaire du Cancer) Oncopole, Institut Claudius Regaud, 1 avenue Irène Joliot-Curie, Toulouse CEDEX 9, 31059, France
| | - Selena Guibaud
- Oncology department IUCT (Institut Universitaire du Cancer) Oncopole, Institut Claudius Regaud, 1 avenue Irène Joliot-Curie, Toulouse CEDEX 9, 31059, France
| | - Olivia Pollet
- Oncology department IUCT (Institut Universitaire du Cancer) Oncopole, Institut Claudius Regaud, 1 avenue Irène Joliot-Curie, Toulouse CEDEX 9, 31059, France
| | - Magali Le Goff
- Oncology department IUCT (Institut Universitaire du Cancer) Oncopole, Institut Claudius Regaud, 1 avenue Irène Joliot-Curie, Toulouse CEDEX 9, 31059, France
| | - Catherine Bardies
- Oncology department IUCT (Institut Universitaire du Cancer) Oncopole, Institut Claudius Regaud, 1 avenue Irène Joliot-Curie, Toulouse CEDEX 9, 31059, France
| | - Véronique Pelagatti
- Pharmacy department IUCT (Institut Universitaire du Cancer) Oncopole, Institut Claudius Regaud, 1 avenue Irène Joliot-Curie, Toulouse CEDEX 9, 31059, France
| | - Jean Marie Canonge
- Pharmacy department IUCT (Institut Universitaire du Cancer) Oncopole, Centre Hospitalier Universitaire, 1 avenue Irène Joliot-Curie, Toulouse CEDEX 9, France
| | - Florent Puisset
- Pharmacy department IUCT (Institut Universitaire du Cancer) Oncopole, Institut Claudius Regaud, 1 avenue Irène Joliot-Curie, Toulouse CEDEX 9, 31059, France.
- Centre de Recherches en Cancérologie de Toulouse (CRCT), Team 14, INSERM UMR1037, Université de Toulouse, 2 avenue Hubert Curien, CS53717, Toulouse CEDEX 1, France.
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7
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AboulFotouh K, Allam AA, El-Badry M, El-Sayed AM. A Self-Nanoemulsifying Drug Delivery System for Enhancing the Oral Bioavailability of Candesartan Cilexetil: Ex Vivo and In Vivo Evaluation. J Pharm Sci 2019; 108:3599-3608. [PMID: 31348934 DOI: 10.1016/j.xphs.2019.07.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 06/05/2019] [Accepted: 07/17/2019] [Indexed: 01/15/2023]
Abstract
The drug delivery of candesartan cilexetil encounters an obstacle of low absolute oral bioavailability which is attributed mainly to its low aqueous solubility and efflux by intestinal P-glycoprotein (P-gp) transporters. However, the extent of P-gp contribution in the reduced oral bioavailability of candesartan cilexetil is not clear. In this study, a previously developed candesartan cilexetil-loaded self-nanoemulsifying drug delivery system (SNEDDS) was evaluated for its ability to increase the drug oral bioavailability via the inhibition of intestinal P-gp transporters. Despite the developed SNEDDS showing P-gp inhibition activity, P-gp-mediated efflux was found to have a minor role in the reduced oral bioavailability of candesartan cilexetil. On the other hand, the high surfactant concentration used in SNEDDS formulation represents a major challenge toward their widespread application especially for chronically administered drugs. The designed acute and subacute toxicity studies revealed that the degree of intestinal mucosal damage decreases as the treatment period increases. The latter observation was attributed to the reversibility of surfactant-induced mucosal damage. Thus, the developed SNEDDS could be considered as a promising delivery system for enhancing the oral bioavailability of chronically administered drugs.
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Affiliation(s)
- Khaled AboulFotouh
- Department of Pharmaceutics, Faculty of Pharmacy, Assiut University, Assiut 71526, Egypt
| | - Ayat A Allam
- Department of Pharmaceutics, Faculty of Pharmacy, Assiut University, Assiut 71526, Egypt
| | - Mahmoud El-Badry
- Department of Pharmaceutics, Faculty of Pharmacy, Assiut University, Assiut 71526, Egypt.
| | - Ahmed M El-Sayed
- Department of Pharmaceutics, Faculty of Pharmacy, Assiut University, Assiut 71526, Egypt
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8
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Abstract
This column is the third in a series exploring drug-drug interactions (DDIs) with a special emphasis on psychiatric medications. The first column in this series discussed why patients being treated with psychiatric medications are at increased risk for taking multiple medications and thus experiencing DDIs and how to recognize such DDIs, and strategies for avoiding them. The second column in the series further discussed strategies for avoiding and/or minimizing adverse outcomes from DDIs. This third column deals with pharmacokinetic considerations concerning DDIs in psychiatric practice. Specifically, this column discusses the 2 major types of pharmacokinetically mediated DDIs: those mediated by cytochrome P450 (CYP) enzymes and those mediated by transport proteins. The role of each of these regulatory proteins in the pharmacokinetics of drugs is reviewed as well as how genetically determined variation in the functional activity of these regulatory proteins can alter the accumulation of a drug in the body (ie, via CYP enzymes) and in specific compartments of the body (ie, via transport proteins), either increasing or decreasing their accumulation leading to either reduced efficacy or increased toxicity. This column further explains how coprescribed drugs can also affect the functional integrity of these regulatory proteins and lead to differences from usual in the accumulation of drugs dependent on the activity of these CYP enzymes and drug transporters. This phenomenon is known as phenoconversion in which a patient can functionally change from his or her genetic status, for example, having extensive or normal metabolism, to having poor or slow metabolism and hence greater accumulation than would be expected based on the patient's genotype.
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9
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Abstract
Transporters in proximal renal tubules contribute to the disposition of numerous drugs. Furthermore, the molecular mechanisms of tubular secretion have been progressively elucidated during the past decades. Organic anions tend to be secreted by the transport proteins OAT1, OAT3 and OATP4C1 on the basolateral side of tubular cells, and multidrug resistance protein (MRP) 2, MRP4, OATP1A2 and breast cancer resistance protein (BCRP) on the apical side. Organic cations are secreted by organic cation transporter (OCT) 2 on the basolateral side, and multidrug and toxic compound extrusion (MATE) proteins MATE1, MATE2/2-K, P-glycoprotein, organic cation and carnitine transporter (OCTN) 1 and OCTN2 on the apical side. Significant drug-drug interactions (DDIs) may affect any of these transporters, altering the clearance and, consequently, the efficacy and/or toxicity of substrate drugs. Interactions at the level of basolateral transporters typically decrease the clearance of the victim drug, causing higher systemic exposure. Interactions at the apical level can also lower drug clearance, but may be associated with higher renal toxicity, due to intracellular accumulation. Whereas the importance of glomerular filtration in drug disposition is largely appreciated among clinicians, DDIs involving renal transporters are less well recognized. This review summarizes current knowledge on the roles, quantitative importance and clinical relevance of these transporters in drug therapy. It proposes an approach based on substrate-inhibitor associations for predicting potential tubular-based DDIs and preventing their adverse consequences. We provide a comprehensive list of known drug interactions with renally-expressed transporters. While many of these interactions have limited clinical consequences, some involving high-risk drugs (e.g. methotrexate) definitely deserve the attention of prescribers.
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Affiliation(s)
- Anton Ivanyuk
- Division of Clinical Pharmacology, Lausanne University Hospital (CHUV), Bugnon 17, 1011, Lausanne, Switzerland.
| | - Françoise Livio
- Division of Clinical Pharmacology, Lausanne University Hospital (CHUV), Bugnon 17, 1011, Lausanne, Switzerland
| | - Jérôme Biollaz
- Division of Clinical Pharmacology, Lausanne University Hospital (CHUV), Bugnon 17, 1011, Lausanne, Switzerland
| | - Thierry Buclin
- Division of Clinical Pharmacology, Lausanne University Hospital (CHUV), Bugnon 17, 1011, Lausanne, Switzerland
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10
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Abstract
Drug-drug interactions (DDIs) occur commonly and may lead to severe adverse drug reactions if not handled appropriately. Considerable information to support clinical decision making regarding potential DDIs is available in the literature and through various systems providing electronic decision support for healthcare providers. The challenge for the prescribing physician lies in sorting out the evidence and identifying those drugs for which potential interactions are likely to become clinically manifest. P-glycoprotein (P-gp) is a drug transporting protein that is found in the plasma membranes in cells of barrier and elimination organs, and plays a role in drug absorption and excretion. Increasingly, P-gp has been acknowledged as an important player in potential DDIs and a growing body of information on the role of this transporter in DDIs has become available from research and from the drug approval process. This has led to a clear need for a comprehensive review of P-gp-mediated DDIs with a focus on highlighting the drugs that are likely to lead to clinically relevant DDIs. The objective of this review is to provide information for identifying and interpreting evidence of P-gp-mediated DDIs and to suggest a classification for individual drugs based on both in vitro and in vivo evidence (substrates, inhibitors and inducers). Further, various ways of handling potential DDIs in clinical practice are described and exemplified in relation to drugs interfering with P-gp.
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11
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Puranik AS, Pao LP, White VM, Peppas NA. In Vitro Evaluation of pH-Responsive Nanoscale Hydrogels for the Oral Delivery of Hydrophobic Therapeutics. Ind Eng Chem Res 2016. [DOI: 10.1021/acs.iecr.6b02565] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Amey S. Puranik
- Department of Chemical Engineering, ‡Department of Biomedical
Engineering, §College of Pharmacy, and ∥Institute for
Biomaterials, Drug Delivery, and Regenerative Medicine, The University of Texas at Austin, Austin, Texas 78712, United States
| | - Ludovic P. Pao
- Department of Chemical Engineering, ‡Department of Biomedical
Engineering, §College of Pharmacy, and ∥Institute for
Biomaterials, Drug Delivery, and Regenerative Medicine, The University of Texas at Austin, Austin, Texas 78712, United States
| | - Vanessa M. White
- Department of Chemical Engineering, ‡Department of Biomedical
Engineering, §College of Pharmacy, and ∥Institute for
Biomaterials, Drug Delivery, and Regenerative Medicine, The University of Texas at Austin, Austin, Texas 78712, United States
| | - Nicholas A. Peppas
- Department of Chemical Engineering, ‡Department of Biomedical
Engineering, §College of Pharmacy, and ∥Institute for
Biomaterials, Drug Delivery, and Regenerative Medicine, The University of Texas at Austin, Austin, Texas 78712, United States
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12
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Telmisartan increases systemic exposure to rosuvastatin after single and multiple doses, and in vitro studies show telmisartan inhibits ABCG2-mediated transport of rosuvastatin. Eur J Clin Pharmacol 2016; 72:1471-1478. [DOI: 10.1007/s00228-016-2130-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 09/07/2016] [Indexed: 12/28/2022]
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13
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Saaby L, Tfelt-Hansen P, Brodin B. The putative P-gp inhibitor telmisartan does not affect the transcellular permeability and cellular uptake of the calcium channel antagonist verapamil in the P-glycoprotein expressing cell line MDCK II MDR1. Pharmacol Res Perspect 2015; 3:e00151. [PMID: 26171231 PMCID: PMC4492727 DOI: 10.1002/prp2.151] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 04/15/2015] [Accepted: 04/18/2015] [Indexed: 12/27/2022] Open
Abstract
Verapamil is used in high doses for the treatment of cluster headache. Verapamil has been described as a P-glycoprotein (P-gp, ABCB1) substrate. We wished to evaluate in vitro whether co administration of a P-gp inhibitor with verapamil could be a feasible strategy for increasing CNS uptake of verapamil. Fluxes of radiolabelled verapamil across MDCK II MDR1 monolayers were measured in the absence and presence of the putative P-gp inhibitor telmisartan (a clinically approved drug compound). Verapamil displayed a vectorial basolateral-to-apical transepithelial efflux across the MDCK II MDR1 monolayers with a permeability of 5.7 × 10(-5) cm sec(-1) compared to an apical to basolateral permeability of 1.3 × 10(-5) cm sec(-1). The efflux could be inhibited with the P-gp inhibitor zosuquidar. Zosuquidar (0.4 μmol/L) reduced the efflux ratio (PB-A/PA-B) for verapamil 4.6-1.6. The presence of telmisartan, however, only caused a slight reduction in P-gp-mediated verapamil transport to an efflux ratio of 3.4. Overall, the results of the present in vitro approach indicate, that clinical use of telmisartan as a P-gp inhibitor may not be an effective strategy for increasing brain uptake of verapamil by co-administration with telmisartan.
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Affiliation(s)
- Lasse Saaby
- Bioneer:FARMA, Faculty of Health and Medical Sciences, University of Copenhagen, Glostrup Hospital Glostrup, Denmark ; Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen Copenhagen, Denmark
| | - Peer Tfelt-Hansen
- Danish Headache Center, Department of Neurology, Glostrup Hospital, University of Copenhagen Glostrup, Denmark
| | - Birger Brodin
- Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen Copenhagen, Denmark
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14
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Chen SZ, Pan PP, Wang SH, Luo J, Hu GX, Xu SS, Zhang L, Yu YF. In vitro and in vivo Drug-Drug Interaction of Losartan and Glimepiride in Rats and Its Possible Mechanism. Pharmacology 2015; 95:133-8. [DOI: 10.1159/000377637] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 01/30/2015] [Indexed: 11/19/2022]
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15
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To KKW, Tomlinson B. Targeting the ABCG2-overexpressing multidrug resistant (MDR) cancer cells by PPARγ agonists. Br J Pharmacol 2014; 170:1137-51. [PMID: 24032744 DOI: 10.1111/bph.12367] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 07/22/2013] [Accepted: 08/23/2013] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND AND PURPOSE Multidrug resistance (MDR), usually mediated by overexpression of efflux transporters such as P-gp, ABCG2 and/or MRP1, remains a major obstacle hindering successful cancer chemotherapy. There has been great interest in the development of inhibitors towards these transporters to circumvent resistance. However, since the inhibition of transporter is not specific to cancer cells, a decrease in the cytotoxic drug dosing may be needed to prevent excess toxicity, thus undermining the potential benefit brought about by a drug efflux inhibitor. The design of potent MDR modulators specific towards resistant cancer cells and devoid of drug-drug interactions will be needed to effect MDR reversal. EXPERIMENTAL APPROACH Recent evidence suggests that the PTEN/PI3K/Akt pathway may be exploited to alter ABCG2 subcellular localization, thereby circumventing MDR. Three PPARγ agonists (telmisartan, pioglitazone and rosiglitazone) that have been used in the clinics were tested for their effect on the PTEN/PI3K/Akt pathway and possible reversal of ABCG2-mediated drug resistance. KEY RESULTS The PPARγ agonists were found to be weak ABCG2 inhibitors by drug efflux assay. They were also shown to elevate the reduced PTEN expression in a resistant and ABCG2-overexpressing cell model, which inhibit the PI3K-Akt pathway and lead to the relocalization of ABCG2 from the plasma membrane to the cytoplasma, thus apparently circumventing the ABCG2-mediated MDR. CONCLUSIONS AND IMPLICATIONS Since this PPARγ/PTEN/PI3K/Akt pathway regulating ABCG2 is only functional in drug-resistant cancer cells with PTEN loss, the PPARγ agonists identified may represent promising agents targeting resistant cells for MDR reversal.
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Affiliation(s)
- Kenneth K W To
- School of Pharmacy, The Chinese University of Hong Kong, Hong Kong
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16
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Surampalli G, K. Nanjwade B, Patil PA. Corroboration of naringin effects on the intestinal absorption and pharmacokinetic behavior of candesartan cilexetil solid dispersions usingin-siturat models. Drug Dev Ind Pharm 2014; 41:1057-65. [DOI: 10.3109/03639045.2014.925918] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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17
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Volpe DA, Hamed SS, Zhang LK. Use of different parameters and equations for calculation of IC₅₀ values in efflux assays: potential sources of variability in IC₅₀ determination. AAPS JOURNAL 2013; 16:172-80. [PMID: 24338112 DOI: 10.1208/s12248-013-9554-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 11/25/2013] [Indexed: 01/07/2023]
Abstract
Drug interactions due to efflux transporters may result in one drug increasing or decreasing the systemic exposure of a second drug. The potential for in vivo drug interactions is estimated through in vitro cell assays. Variability in in vitro parameter determination (e.g., IC₅₀ values) among laboratories may lead to different conclusions in in vivo interaction predictions. The objective of this study was to investigate variability in in vitro inhibition potency determination that may be due to calculation methods. In a Caco-2 cell assay, the absorptive and secretive permeability of digoxin was measured in the presence of spironolactone, itraconazole and vardenafil. From the permeability data, the efflux ratio and net secretory flux where calculated for each inhibitor. IC₅₀ values were then calculated using a variety of equations and software programs. All three drugs decreased the secretory transport of digoxin in a concentration-dependent manner while increasing digoxin's absorption to a lesser extent. The resulting IC₅₀ values varied according to the parameter evaluated, whether percent inhibition or percent control was applied, and the computational IC₅₀ equation. This study has shown that multiple methods used to quantitate the inhibition of drug efflux in a cell assay can result in different IC₅₀ values. The variability in the results in this study points to a need to standardize any transporter assay and calculation methods within a laboratory and to validate the assay with a set of known inhibitors and non-inhibitors against a clinically relevant substrate.
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Affiliation(s)
- Donna A Volpe
- Center for Drug Evaluation and Research, Food and Drug Administration, 10903 New Hampshire Ave., Silver Spring, Maryland, 20993-0002, USA,
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18
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Gurunath S, Nanjwade BK, Patil PA. Oral bioavailability and intestinal absorption of candesartan cilexetil: role of naringin as P-glycoprotein inhibitor. Drug Dev Ind Pharm 2013; 41:170-6. [DOI: 10.3109/03639045.2013.850716] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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19
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Azizi M, Blanchard A, Charbit B, Wuerzner G, Peyrard S, Ezan E, Funck-Brentano C, Ménard J. Effect of Contrasted Sodium Diets on the Pharmacokinetics and Pharmacodynamic Effects of Renin–Angiotensin System Blockers. Hypertension 2013; 61:1239-45. [DOI: 10.1161/hypertensionaha.113.01196] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Dietary sodium, the main determinant of the pharmacodynamic response to renin–angiotensin system blockade, influences the pharmacokinetics of various cardiovascular drugs. We compared the effect of contrasted sodium diets on the pharmacokinetics of single oral doses of 8 mg candesartan cilexetil, 160 mg valsartan, 10 mg ramipril, and 50 mg atenolol administered to 64 (16 per group) normotensive male subjects randomly assigned to sodium depletion (SD) or sodium repletion (SR) in a crossover study. Pharmacodynamic response was assessed as the increase in plasma renin concentration for renin–angiotensin system blockers and electrocardiographic changes in PR interval duration for atenolol. The area under the curve (AUC) for plasma candesartan and atenolol concentrations was significantly lower for SR than for SD (respective ratios of AUC
0–∞
: 0.74; [90% CI, 0.66–0.82] and 0.69 [90% CI, 0.54–0.88], respectively), indicating a lack of bioequivalence between SR and SD. SR did not affect the pharmacokinetics of valsartan or ramipril. The increase in plasma renin concentration with the 3 renin–angiotensin system blockers was 10 times lower during the SR than the SD period. In the multiple regression analysis, the AUC
0–24
of plasma drug concentration explained <1% and 21% of the variance of the AUC
0–24
of delta plasma renin concentration for candesartan (
P
=0.8882/
P
=0.0368) during the SR and SD periods, respectively. The atenolol-induced lengthening of PR interval was fully reversed by SR. Thus, sodium balance modulates the pharmacokinetics of candesartan cilexetil and atenolol, with measurable effects on the selected pharmacodynamic end points.
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Affiliation(s)
- Michel Azizi
- From the Assistance Publique des Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France (M.A., A.B., G.W., S.P.); Université Paris Descartes, Faculté de Médecine, Paris, France (M.A., A.B., G.W., J.M.); INSERM CIC-9201 (M.A., A.B., J.M.), CIC-9304 and UMRS-956 (B.C., C.F.-B.), Paris, France; Assistance Publique des Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Department of Pharmacology and UMRS-956, Paris, France (B.C., C.F.-B.); UPMC Université Paris 06, Faculty of Medicine, Paris,
| | - Anne Blanchard
- From the Assistance Publique des Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France (M.A., A.B., G.W., S.P.); Université Paris Descartes, Faculté de Médecine, Paris, France (M.A., A.B., G.W., J.M.); INSERM CIC-9201 (M.A., A.B., J.M.), CIC-9304 and UMRS-956 (B.C., C.F.-B.), Paris, France; Assistance Publique des Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Department of Pharmacology and UMRS-956, Paris, France (B.C., C.F.-B.); UPMC Université Paris 06, Faculty of Medicine, Paris,
| | - Beny Charbit
- From the Assistance Publique des Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France (M.A., A.B., G.W., S.P.); Université Paris Descartes, Faculté de Médecine, Paris, France (M.A., A.B., G.W., J.M.); INSERM CIC-9201 (M.A., A.B., J.M.), CIC-9304 and UMRS-956 (B.C., C.F.-B.), Paris, France; Assistance Publique des Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Department of Pharmacology and UMRS-956, Paris, France (B.C., C.F.-B.); UPMC Université Paris 06, Faculty of Medicine, Paris,
| | - Grégoire Wuerzner
- From the Assistance Publique des Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France (M.A., A.B., G.W., S.P.); Université Paris Descartes, Faculté de Médecine, Paris, France (M.A., A.B., G.W., J.M.); INSERM CIC-9201 (M.A., A.B., J.M.), CIC-9304 and UMRS-956 (B.C., C.F.-B.), Paris, France; Assistance Publique des Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Department of Pharmacology and UMRS-956, Paris, France (B.C., C.F.-B.); UPMC Université Paris 06, Faculty of Medicine, Paris,
| | - Séverine Peyrard
- From the Assistance Publique des Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France (M.A., A.B., G.W., S.P.); Université Paris Descartes, Faculté de Médecine, Paris, France (M.A., A.B., G.W., J.M.); INSERM CIC-9201 (M.A., A.B., J.M.), CIC-9304 and UMRS-956 (B.C., C.F.-B.), Paris, France; Assistance Publique des Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Department of Pharmacology and UMRS-956, Paris, France (B.C., C.F.-B.); UPMC Université Paris 06, Faculty of Medicine, Paris,
| | - Eric Ezan
- From the Assistance Publique des Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France (M.A., A.B., G.W., S.P.); Université Paris Descartes, Faculté de Médecine, Paris, France (M.A., A.B., G.W., J.M.); INSERM CIC-9201 (M.A., A.B., J.M.), CIC-9304 and UMRS-956 (B.C., C.F.-B.), Paris, France; Assistance Publique des Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Department of Pharmacology and UMRS-956, Paris, France (B.C., C.F.-B.); UPMC Université Paris 06, Faculty of Medicine, Paris,
| | - Christian Funck-Brentano
- From the Assistance Publique des Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France (M.A., A.B., G.W., S.P.); Université Paris Descartes, Faculté de Médecine, Paris, France (M.A., A.B., G.W., J.M.); INSERM CIC-9201 (M.A., A.B., J.M.), CIC-9304 and UMRS-956 (B.C., C.F.-B.), Paris, France; Assistance Publique des Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Department of Pharmacology and UMRS-956, Paris, France (B.C., C.F.-B.); UPMC Université Paris 06, Faculty of Medicine, Paris,
| | - Joël Ménard
- From the Assistance Publique des Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France (M.A., A.B., G.W., S.P.); Université Paris Descartes, Faculté de Médecine, Paris, France (M.A., A.B., G.W., J.M.); INSERM CIC-9201 (M.A., A.B., J.M.), CIC-9304 and UMRS-956 (B.C., C.F.-B.), Paris, France; Assistance Publique des Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Department of Pharmacology and UMRS-956, Paris, France (B.C., C.F.-B.); UPMC Université Paris 06, Faculty of Medicine, Paris,
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20
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Gurunath S, Nanjwade BK, Patila PA. Enhanced solubility and intestinal absorption of candesartan cilexetil solid dispersions using everted rat intestinal sacs. Saudi Pharm J 2013; 22:246-57. [PMID: 25067902 DOI: 10.1016/j.jsps.2013.03.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Accepted: 03/24/2013] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Candesartan cilexetil (CAN) is a poor aqueous soluble compound and a P-glycoprotein (P-gp) efflux pump substrate. These key factors are responsible for its incomplete intestinal absorption. METHODS In this study, we investigated to enhance the absorption of CAN by improving its solubility and inhibiting intestinal P-gp activity. A phase solubility method was used to evaluate the aqueous solubility of CAN in PVP K30 (0.2-2%). Gibbs free energy [Formula: see text] values were all negative. Solubility was enhanced by the freeze drying technique. The in vitro dissolution was evaluated using the USP paddle method. The interaction between drug and carrier was evaluated by Fourier transform infrared spectroscopy (FTIR), X-ray diffraction (XRD) and Differential scanning calorimetry (DSC) studies. Naringin was selected as P-gp inhibitor. Absorption studies were performed using the everted gut sac model from rat jejunum. The drug analysis was performed by HPLC. RESULTS FTIR spectra revealed no interaction between drug and PVP K30. From XRD and DSC data, CAN was in the amorphous form, which explains the cumulative release of drug from its prepared systems. We noticed an enhancement of CAN absorption by improving its solubility and inhibiting the P-gp activity. The significant results (p < 0.05) were obtained for freeze dried solid dispersions in the presence of P-gp inhibitor than without naringin (15 mg/kg) with an absorption enhancement of 8-fold. CONCLUSION Naringin, a natural flavonoid, has no undesirable side effects. Therefore, it could be employed as an excipient in the form of solid dispersions to increase CAN intestinal absorption and its oral bioavailability.
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Affiliation(s)
- S Gurunath
- Department of Pharmacology, KLE University, Belgaum - Karnataka, India
| | | | - P A Patila
- Department of Pharmacology, KLE University, Belgaum - Karnataka, India
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21
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Michel MC, Foster C, Brunner HR, Liu L. A systematic comparison of the properties of clinically used angiotensin II type 1 receptor antagonists. Pharmacol Rev 2013; 65:809-48. [PMID: 23487168 DOI: 10.1124/pr.112.007278] [Citation(s) in RCA: 211] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Angiotensin II type 1 receptor antagonists (ARBs) have become an important drug class in the treatment of hypertension and heart failure and the protection from diabetic nephropathy. Eight ARBs are clinically available [azilsartan, candesartan, eprosartan, irbesartan, losartan, olmesartan, telmisartan, valsartan]. Azilsartan (in some countries), candesartan, and olmesartan are orally administered as prodrugs, whereas the blocking action of some is mediated through active metabolites. On the basis of their chemical structures, ARBs use different binding pockets in the receptor, which are associated with differences in dissociation times and, in most cases, apparently insurmountable antagonism. The physicochemical differences between ARBs also manifest in different tissue penetration, including passage through the blood-brain barrier. Differences in binding mode and tissue penetration are also associated with differences in pharmacokinetic profile, particularly duration of action. Although generally highly specific for angiotensin II type 1 receptors, some ARBs, particularly telmisartan, are partial agonists at peroxisome proliferator-activated receptor-γ. All of these properties are comprehensively reviewed in this article. Although there is general consensus that a continuous receptor blockade over a 24-hour period is desirable, the clinical relevance of other pharmacological differences between individual ARBs remains to be assessed.
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Affiliation(s)
- Martin C Michel
- Department of Clinical Development & Medical Affairs, Boehringer Ingelheim, 55216 Ingelheim, Germany.
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22
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23
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Kataoka M, Takashima T, Shingaki T, Hashidzume Y, Katayama Y, Wada Y, Oh H, Masaoka Y, Sakuma S, Sugiyama Y, Yamashita S, Watanabe Y. Dynamic analysis of GI absorption and hepatic distribution processes of telmisartan in rats using positron emission tomography. Pharm Res 2012; 29:2419-31. [PMID: 22618800 DOI: 10.1007/s11095-012-0768-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Accepted: 04/25/2012] [Indexed: 12/13/2022]
Abstract
PURPOSE To dynamically analyze the processes of oral absorption and hepatobiliary distribution of telmisartan using positron emission tomography (PET). METHODS (11)C-labeled telmisartan ([(11)C]TEL) was orally administered to rats with or without non-radiolabeled telmisartan (0.5, and 10 mg/kg). PET scanning of abdominal region and whole body was performed under conscious condition. In situ intestinal closed loop study in rats and in vitro permeation study in MDR1-MDCK II cell monolayers were also conducted. RESULTS After oral administration of [(11)C]TEL, systemic bioavailability and hepatic distribution of radioactivity increased non-linearly with dose. In the intestinal lumen, both telmisartan and its glucuronide were detected and the ratio of telmisartan decreased dramatically at high dose of telmisartan. In situ closed loop study showed most of telmisartan-glucuronide detected in the intestinal lumen was derived from the bile excretion. In addition, in vitro permeation study revealed that telmisartan is a substrate of P-glycoprotein. CONCLUSION PET imaging analysis successfully demonstrated the processes of intestinal absorption and hepatic distribution of telmisartan. PET study combined with appropriate in situ and in vitro experiments is highly expected to be a potent tool for better understanding of GI absorption and subsequent tissue distribution of various drugs and drug candidates.
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Affiliation(s)
- Makoto Kataoka
- RIKEN Center for Molecular Imaging Science, 6-7-3 Minatojima minamimachi, Chuo-ku, Kobe, Hyogo 650-0047, Japan
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Bochud M, Burnier M, Guessous I. Top Three Pharmacogenomics and Personalized Medicine Applications at the Nexus of Renal Pathophysiology and Cardiovascular Medicine. CURRENT PHARMACOGENOMICS AND PERSONALIZED MEDICINE 2011; 9:299-322. [PMID: 23049672 PMCID: PMC3460365 DOI: 10.2174/187569211798377135] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Revised: 10/08/2011] [Accepted: 10/13/2011] [Indexed: 12/18/2022]
Abstract
Pharmacogenomics is a field with origins in the study of monogenic variations in drug metabolism in the 1950s. Perhaps because of these historical underpinnings, there has been an intensive investigation of 'hepatic pharmacogenes' such as CYP450s and liver drug metabolism using pharmacogenomics approaches over the past five decades. Surprisingly, kidney pathophysiology, attendant diseases and treatment outcomes have been vastly under-studied and under-theorized despite their central importance in maintenance of health, susceptibility to disease and rational personalized therapeutics. Indeed, chronic kidney disease (CKD) represents an increasing public health burden worldwide, both in developed and developing countries. Patients with CKD suffer from high cardiovascular morbidity and mortality, which is mainly attributable to cardiovascular events before reaching end-stage renal disease. In this paper, we focus our analyses on renal function before end-stage renal disease, as seen through the lens of pharmacogenomics and human genomic variation. We herein synthesize the recent evidence linking selected Very Important Pharmacogenes (VIP) to renal function, blood pressure and salt-sensitivity in humans, and ways in which these insights might inform rational personalized therapeutics. Notably, we highlight and present the rationale for three applications that we consider as important and actionable therapeutic and preventive focus areas in renal pharmacogenomics: 1) ACE inhibitors, as a confirmed application, 2) VDR agonists, as a promising application, and 3) moderate dietary salt intake, as a suggested novel application. Additionally, we emphasize the putative contributions of gene-environment interactions, discuss the implications of these findings to treat and prevent hypertension and CKD. Finally, we conclude with a strategic agenda and vision required to accelerate advances in this under-studied field of renal pharmacogenomics with vast significance for global public health.
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Affiliation(s)
- Murielle Bochud
- Institute of Social and Preventive Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Michel Burnier
- Service of Nephrology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Idris Guessous
- Institute of Social and Preventive Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
- Unit of Population Epidemiology, Division of Primary Care medicine, Department of Community Medicine and Primary Care and Emergency Medicine, Geneva University Hospital, Geneva, Switzerland
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Abstract
The human colon adenocarcinoma Caco-2 and Madin–Darby canine kidney epithelial cell lines provide in vitro tools to assess a drug’s permeability and transporter interactions during discovery and development. The cells, when cultured on semiporous filters, form confluent monolayers that model the intestinal epithelial barrier for permeability, transporter and drug-interaction assays. The applications of these assays in pharmaceutical research include qualitative prediction and ranking of absorption, determining mechanism(s) of permeability, formulation effects on drug permeability, and the potential for transporter-mediated drug–drug interactions. This review focuses on recent examples of Caco-2 and Madin–Darby canine kidney cells assays for drug permeability including transfected and knock-down cells, miniaturization and automation, and assay combinations to better understand and predict intestinal drug absorption.
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26
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Deppe S, Böger RH, Weiss J, Benndorf RA. Telmisartan: a review of its pharmacodynamic and pharmacokinetic properties. Expert Opin Drug Metab Toxicol 2011; 6:863-71. [PMID: 20509777 DOI: 10.1517/17425255.2010.494597] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
IMPORTANCE OF THE FIELD Telmisartan belongs to the angiotensin II type 1 (AT1) receptor antagonizing class of antihypertensives, which are widely recognized and increasingly prescribed because of their good tolerability. Moreover, due to the results of the ONTARGET trial program, telmisartan was the first AT1 receptor antagonist to receive approval for the prevention of cardiovascular events in cardiovascular high risk patients, thereby, indicating that its clinical importance will further increase. AREAS COVERED IN THIS REVIEW This article reviews the pharmacokinetic and pharmacodynamic properties of telmisartan with a special focus on novel pharmacokinetic characteristics of the drug. WHAT THE READER WILL GAIN An overview of the published data regarding the pharmacokinetic properties of telmisartan as well as a summary of the results from selected small exploratory and large clinical outcome trials involving telmisartan. TAKE HOME MESSAGE Telmisartan is a safe and effective alternative for the treatment of hypertension. Moreover, due to its good tolerability, an increasing use of telmisartan in cardiovascular high risk patients can be anticipated. This will grant further experimental and clinical research on AT1 receptor-independent pharmacodynamics of telmisartan as well as on telmisartan-related drug safety issues.
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Affiliation(s)
- Sylvia Deppe
- Technical University of Braunschweig, Institute of Pharmacology, Toxicology, and Clinical Pharmacy, Mendelssohnstr. 1, D-38106 Braunschweig, Germany
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27
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Takizawa Y, Kishimoto H, Kitazato T, Tomita M, Hayashi M. Changes in the Localization of Ileal P-Glycoprotein Induced by Intestinal Ischemia/Reperfusion. Biol Pharm Bull 2011; 34:408-14. [DOI: 10.1248/bpb.34.408] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Yusuke Takizawa
- Department of Drug Absorption and Pharmacokinetics, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences
| | - Hisanao Kishimoto
- Department of Drug Absorption and Pharmacokinetics, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences
| | - Takuya Kitazato
- Department of Drug Absorption and Pharmacokinetics, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences
| | - Mikio Tomita
- Department of Drug Absorption and Pharmacokinetics, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences
| | - Masahiro Hayashi
- Department of Drug Absorption and Pharmacokinetics, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences
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